006- Medication Assisted Treatment for Opiates and Alcohol

006- Medication Assisted Treatment for Opiates and Alcohol

Medication assisted therapy is becoming a very hotly debated topic. Some of these medications block cravings or the “high,” while others address the underlying mood and mental health issues that may be maintaining the addiction. In this episode we will examine the potential benefits and drawbacks of these medications.

Show Notes

Medication Assisted Therapy Alcohol and Opiates Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC, NCC Executive Director, AllCEUs Objectives Review some myths about Medication Assisted Treatment Identify medications used to treat opiate dependence Identify medications used to treat alcohol dependence Discuss the mechanisms of action Evaluate pros and cons of each Myths Medications are a crutch We do what is more rewarding than the alternative Medications can make sobriety “feel better” by addressing underlying neurochemical imbalances Medications can remove the rewards from use by Making it unpleasant (Antabuse) Removing the “high” (Buprenorphine, Naltrexone) Both (Suboxone) Remember recovery is more than just NOT using. Medications can help ease the transition until the brain has rebalanced and the new lifestyle is in full swing Myths Using medication goes against 12-Step Philosophy Alcoholics Anonymous does not encourage AA participants to not use prescribed medications or to discontinue taking prescribed medications The Big Book states, “God has abundantly supplied this world with fine doctors, psychologists, and practitioners of various kinds. Do not hesitate to take your health problems to such person …Try to remember that though God has wrought miracles among us, we should never belittle a good doctor or psychiatrist. Their services are often indispensable in treating a newcomer and in following his case afterward.”

Pros Medications Can… Increase energy and motivation (dopamine and norepinephrine) while the person’s brain and body are recovering Remove some of the reinforcing effects of the drugs Prevent relapse by making relapse very unpleasant Reduce the intensity of co-occurring disorders Reduce conflict/improve social support Reduce absenteeism from work Cons of Medication Physicians who are educated about addiction treatment and endorse a biopsychosocial model of treatment are difficult to find Medications can give a false sense of security Medications may provide false hope Medications have side effects There is a stigma associated with the use of medications Costs money

Buprenorphine Is as partial opioid agonist (ceiling effect) Reduces the symptoms of withdrawal from misused opiates Can be abused Methadone Full Mu opiate agonist (suppresses cravings) Lessens the painful symptoms of opiate withdrawal and blocks the euphoric effects of opiate drugs Considered relatively safe during pregnancy and breastfeeding Opiate w/d during pregnancy can trigger contractions and miscarriage

SAMHSA TIP 43 MAT for Opioid Addiction Naltrexone Decreases the pleasurable effects of alcohol or opiates by blocking opiate receptors Alcohol abstinence is not required, but opiate abstinence is Naltrexone will cause opiate withdrawal in dependent users Third-Party Payer Acceptance: Oral is covered by most major insurance carriers, Medicare, Medicaid, and the VA Vivitrol is not covered in many cases

Acamprosate Third-Party Payer Acceptance: Does qualify for the Patient Assistance Program through Forest Laboratories, Inc. Covered by most major insurance carriers, Medicare, Medicaid, and the VA (if naltrexone is contraindicated)

Disulfiram (Antabuse) Makes patients physically sick if they drink Third-Party Payer Acceptance: Covered by most major insurance carriers, Medicare, Medicaid, and the VA Disulfiram blocks the enzyme acetaldehyde dehydrogenase alcohol is broken down in the liver to acetaldehyde; acetaldehyde is converted by the enzyme acetaldehyde dehydrogenase to acetic acid. This causes acetaldehyde to accumulate in the blood at 5 to 10 times higher than alcohol alone leading to toxcicity

Disulfiram (Antabuse) The acute toxic reaction lasts about an hour, but will linger while there is alcohol in the blood Can be triggered by alcohol containing products like cough syrup Patients taking disulfiram should not be exposed to ethylene dibromide or its vapors, paint fumes, paint thinner, varnish or shellac Exercise extreme caution when applying aftershave, mouthwash, lotions, colognes and rubbing alcohol The disulfiram-alcohol reaction can be triggered up to two weeks after the last dose of disulfiram PATIENT and S.O. EDUCATION IS VITAL

Naltrexone Decreases the pleasurable effects of alcohol or opiates by blocking opiate receptors Alcohol abstinence is not required, but opiate abstinence is Naltrexone will cause opiate withdrawal in dependent users Third-Party Payer Acceptance: Oral is covered by most major insurance carriers, Medicare, Medicaid, and the VA Vivitrol is not covered in many cases

Newer Meds ONDANSETRON Sold under the name Zofran, and works through the serotoninergic system especially in regard to the serotonin3 receptor and its effect on dopamine. In alcoholics, it is possible that there is a heightened sensitivity of the serotonin3 receptor making alcohol more rewarding. If this receptor could be blocked, there would be a decrease in alcohol-induced dopamine release, resulting in a decrease in alcoholic-drinking behavior. Newer Medications NALMEFENE is an opioid antagonist similar to naltrexone (ReVia) without the risk of liver toxicity, and it is longer acting. GABAPENTIN (Neurontin) is being used for pain management, anxiety, & insomnia, problems very common among alcohol-dependent patients. Comorbid Conditions Anxiety SSRIs Buspar Insomnia SSRIs Gabapentin Atypical Antipsychotics Depression SSRIs Atypical Antipsychotics Pain SSRI/SNRI/Tricyclics Anticonvulants

Summary Both opiates and alcohol activate opiate receptors MAT is used to make sobriety more rewarding and reduce relapse triggers in early recovery It is essential to address comorbid conditions in addition to the substance References http://www.naadac.org/assets/1959/storie_mat_alcohol.pdf https://www.oasas.ny.gov/AdMed/meds/meds.cfm

AllCEUs started providing affordable CEUs and counseling continuing education, including online ceus and webinar based counseling ceus, in 2006 to help counselors licensed by their state board of professional counseling or state board of alcohol and drug abuse access affordable counselor continuing education, meet their continuing education requirements and enhance their addiction or mental health counseling practice. Since then, other companies have joined the marketplace to provide lpc continuing education including quantumunitsed, ce4less, Aspira aspirace, tzkseminars, i-counseling, accessceu, CEUbynet, pdresources. AllCEUs pioneered the model of offering unlimited CEU packages for a flat rate. We also were the first to offer live webinars each week for $5 per counseling webinar. We pride ourselves on having the largest catalog, with well over 200 multimedia, online counseling CEU courses. AllCEUs is an approved continuing education provider by the Connecticut Certification Board, The Florida Certification Board, FCB, The Alcohol and Drug Abuse Counseling Board of Georgia, ADACB-GA, NAADAC, the association for addiction professionals, the Texas Board of Social Work, The Texas Board of Professional Counseling, The Texas Board of Marriage and Family Therapy, California Consortium of Addiction Programs and Professionals, the Florida Board of Social Work, Mental Health Counseling and Marriage and Family Therapy and many other boards. It is important to note that, in most states, CEUs are NOT required to be NBCC approved, and most states accept ceus which are NOT from an NBCC approved continuing education provider or ACEP. For specific information about which other approval bodies your state accepts, you can visit our approvals page: https://cdn1.allceus.com/wp-content/uploads/2017/01/NewStateApprovalChart2017-1.pdf which provides a summary and links to the documents of the various state licensing boards for counselors, therapists and social workers. For mental health counselors, social workers and marriage and family therapists in Florida, AllCEUs reports your counseling CEUs to CE Broker. Whether you are a LCSW, MSW, LMFT, LMFT LMHC, LPC, LPCC, LCPC, CCMHC, MHC, CADC, LADC, CAP, LCDC, recovery coach, psychotherapist, pastoral counselor, addiction counselor, substance abuse counselor, recovery specialist, behavioral health technician needing mental health or addiction counseling CEUs online, or wanting to get certified as an addiction professional, AllCEUs has a variety of affordable online counseling CEUs, online addiction counselor certificate training tracks and face to face training options. Our unlimited CE packages provide professional counselor continuing education (CEUs) in addiction counseling, transdisciplinary foundations of addiction counseling, screening and assessment, diagnosis, family therapy, pharmacology, psychopharmacology, case management, crisis intervention, counseling tools, dialectical behavior therapy, mindfulness, acceptance and commitment therapy, ethics, supervision, working with adolescents, and many more.